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Stoma bags, why and how
When you have a stoma you have no control over your stool or urine, you cannot keep it inside anymore. That is why the stool or the urine has to be collected inside a bag, that is stuck to the skin of your belly around the stoma-opening. Because you cannot time the moments of discharge, you always have to wear a bag, it is not possible to take it off for a time. Even while swimming, sleeping, visiting the sauna or having sex, you will need to have a bag on.
Nowadays there is a choice of sizes and it is possible to choose a smaller size for certain activities. Also, the appliances are so well-constructed, that one can sometimes be unaware of having it on.
There are two systems. The one-part systems and the two-part systems.
In the one-part systems the bag and the adhesive (that sticks to the belly) form a whole.
In the two-part-systems the bag and the the adhesive-part are two seperate items.
In the one-part systems you have to peel the adhesive from the skin, and stick on a new one every time you change the bag. This changing has te be done once or twice a day and this can be hard on the skin. On the other hand, the one-part system is thin and flexible and will hardly show under clothes.
Brand:
Dansac
The two-part-system consists of an adhesive part, called the flange, or wafer or base-plate and a separate matching bag, that fits on the flange.
The bag can be attached to the flange in different ways.
The main types of attachments are: the so called Tupperware connection and the stick-on connection.
The base plate of the tupperware-type-connections has a rather stiff rubber-ring, and the bag has a fitting rubber ring. When the bag is changed , one removes the old bag, by unclicking it and one clicks a fresh bag on to the base-plate.The sound of the clicking and the soundness of the locking resembles the old Tupperware boxes. The base-plate can stay attached to the skin for days.
Brand:
Hollister
The base-plate of the stick-on connection-type has a flat surface and the bags have a sticking part that fits on to this flat surface. The bag can be removed and changed several times, while the base-plate stays on the skin.
This two-part system is more flexible and thinner than the “Tupperware”-system, because it contains no stiff ring.
Brand from left to right:
Convatec and the last two from
Coloplast
The amount of time one can wear the same base-plate differs from one person to another. This holds true for all systems. It depends , among other things, on the sensiblility of the skin, on the amount of sweating, on certain qualities of the discharge. (When the stool is thinner, it will damage the base-plate more, also when the urine has a high PH).
Most systems contain a carbon filter to let the gasses escape without smell. The ileobags have a double lining to keep the filter dry, by separating the gasses and the wet material. The filters function for about 8 to 12 hours, depending on the consistency of the discharge. After this time the gasses cannot escape anymore and can make the bag puff up.
While swimming and showering you need to keep this filter dry and for this purpose special little stickers have been developed, these go with every pack of (filltered) stomabags
Urostomabags have no need of a filter, because with urine production there is no gas.
Brand from left to right: Welland,
Coloplast,
Dansac and Hollister
Recently stomabags with a duo-filter have been developed (Coloplast) to improve the functions of neutralizing smells and letting the gass escape.
You don’t have te be afraid of noticeable smells. When you change the bag regularly and when it is well-closed the people around you will not smell anything. Every stoma-bag that leaves the factory is quality-tested. One of the quality-norms is strength and the ability to withstand high pressure. The bags are tested for strength by putting them on a viewing-machine (see photo left) to see if the thickness of the material is even and if it contains no vulnerable spots. Another machine blows the bags up and puts pressure on them to see if the seams are strong. And the attachment of the rubber ring is tested by a special pulling-machine (see photo right).
Picture source:
Convatec
Most bags exist in beige “skin-color” as well as in a transparent version. The transparent ones are used mostly in the hospital when it is important to constantly check the stoma and the output.
The beige ones are non-transparent, an advantage when you do not want to see the content.
The basic material of stomabags is a shiny plastic. This can stick to the skin when you are sweating and makes a rustling noise when moved. That is why these days many stomabags have a soft non-woven cover, that feels nicer on the skin than the plastic material, absorbs the sweat and has less rustling noise.
Brand left: Hollister, right: Dansac
There is a type of stomabag, that contains a hidden transparent part. It is made by overlapping two parts of the non-woven cover, which you can pull apart, if you want to see the stoma. This is useful when you want to be able to check your stoma, also it makes the changing of bags (of a one-system type) easier. The diffence with a transparent bag is that you can cover the see-through part.
A stoma bag can have a number of lips (see above). If there is a lip to the left and the right, then this is for attaching a belt. This is an elastic band which you wear around your waist so that the base plate is firmly pressed against your stomach (see under). If there is 1 lip, or a third one, then this is often used with a two piece system, to make it easier to remove the bag.
Picture source:
uzleuven
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Overview of the differences between the two main systems
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One-part stoma-sytem |
Two-part stoma-sytem |
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Changing a bag takes more time. |
Changing a bag takes not as much time, but changing the base-plate (once or twice a week) a bit more.
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Flexible, adapts to the shape of the skin.
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The base-plate is rather stiff, especially round the ring. |
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Very flat, not noticeable under clothes.
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Reasonably flat, hardly visible under tight clothes, not visible under loose clothing. |
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Not many possibilities for variation. |
Universal system, on the same base-plate-ring a variety of bags will fit(for example a smaaler bag or a bag od another brand). |
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Once stuck on, you cannot change the direction of the bag. |
The direction of the bag can be changed, for instance, to sideways. |
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The stoma is more vulnerable, only covered by a thin pastic layer.
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The stoma is better protected inside the stiff ring.
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The skin has more to endure because the adhesive is peeled from the skin a few times a day.
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The skin gets more rest, because the peeling of of the base-plate is only done a few times a week. |
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The material takes up less space in your baggage while travelling.
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Takes up more space in your babbage, because of the thicker shape.
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More expensive, because the adhesive, containing valuable hydrocolloid skinprotector, is thrown away with the bag. |
Less expensive, because the adhesive base-plate, containing valuable hydrocolloid skinprotector, is used for a longer time. |
Source: De Nederlandse stomavereniging
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What kind of bag goes with which type of stoma?
People with an ileostoma produce a rather liquid discharge, so they use a drainable bag, that has a re-sealable opening on the underside. By using this opening they can empty the bag in the toilet, so they don’t have to use a new bag every time. People with a colostoma placed in the higher part of the bowels also have a rather thin output, because the bowels have not been able to finish the process of thickening the stool. For them the drainable ileo-bags are more suitable than the closed colostoma bags.
The opening in the ileobag is sometimes closed with a seperate clip. When using this type of bag it is important to always carry a spare clip, to ensure a secure fastening.
Brand:
Welland
Nowadays you can get ileobags with a clipless velcro re-sealable opening.These are available in different kinds. You have to experiment yourself which is the most suitable for you personally.
Brand from left to right: Dansac,
Coloplast, BBraun
For people in a wheelchair with an ileostomy, a tip from Christiaan: “I searched for a solution to independent emptying of the bag. The leg bag is normally chosen. In my personal case, because I can push myself forwards in the wheelchair, I considered the option of the long high flow ileo bag with button closing (which makes the bag a bit longer) by BBraun Almarys Twin+. As far as I am aware this is the only make which offers a long bag with a button closure. For me this works excellently, aided by the fact that thanks to the electrical height adjustment of my wheelchair, I can reach well above the toilet. The advantage of this bag with button closure is that it is possible to add a night bag via tubing, which can be a solution for bedridden people. “
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Brand:
BBraun
People with a colostoma placed on the lower part of the bowels produce a thicker stool and mostly use a closed bag. The consistency of the stool makes emptying the bag through a small opening impossible.
The choice between a one-part systen and a two-part system (for a colostoma-owner) depends among other things on the amount of stool one produces. If the stoma produces a lot it is better to have a two-piece-system because a one-part-system would mean peeling the adhesive of the skin rather often.
Brand from left to right: Dansac,
Hollister,
Coloplast and
Convatec
For a while there have also existed colostomy bags which can be flushed through the toilet, for example Flair Xtra from Welland and NovaLife 2 from Dansac. You can choose if you wish to throw away the bag and contents or flush it away. This is a new concept. The bag consists of an inner and an outer bag. The inner bag is environmentally friendly, dissolving completely without causing any damage to nature and consists of less paper than is used in a normal toilet visit. The outer bag is a “normal“ colostomy bag with a non-woven layer. Through a simple and quick handling you can separate the outer bag from the inner bag. Then you can throw the inner bag away in the toilet and flush. This can be useful is for example there is no bin in the toilet. You can then put the outer layer in your trouser pocket until you find a bin. People also consider it a good idea that the faeces goes into the toilet and not into the bin. After research in England it appears that the chance of obstruction of the toilet is 0,000001%. This percentage is no larger than that of normal toilet paper.
Left: Welland (Flair-xtra.com)
and right:
Dansac
People with a colostoma, who rinse their bowels, can use a stoma-cap. This is a small round stomabag, available as a one-part systen and a two-part system. Often it contains a gauze to collect the mucous discharge from the bowels.
Brand from left to right:
Dansac and the other two
Coloplast
The urostoma-bag is also drainable and has an opening shaped like a tap, so it is easy to empty the urine into the toilet.
Brand:
Convatec
The bag also has a double lining to make sure the urine in the bag does not get into contact with the base-plate.
It is possible to attach a bigger nightbag to the tap of an urostomy-bag, so you don’t have to get up at night to empty the bag. For this reason the tap has a special inbuilt valve, that allows urine to drip into the nightbag , but does not allow the urine to get back into the upper bag. In this way leakage and urinary infections are prevented.
Brand from left to right:
Coloplast,
Hollister,
Convatec and
Dansac.
A night bag can be attached to an urostomy bag, enabling you not to have to empty your bag overnight. In order to prevent a vacuum it is advisable to leave a layer of urine in the stoma bag. Naturally the night bag must hang lower than the mattress. Hang it over a bucket. If the urine does not flow well through you can put a bit of water in the night bag before attaching it. If you rinse your night bag through well in the morning, for example with water and vinegar, you can reuse it for a maximum of one week. For extra movement ability you could attach an extra length of tubing.
Brand:
Coloplast and
Welland
For children and babies and even for premature babys special small bags are available. But baby’s with a urostomy do not have to wear a stomabag, a wellplaced nappy will do.
The system for babies and children is not just a miniature version of the adult one. For one it needs to be very flexible, because babies and children move a lot. And children produce more output, relative to their size and weight than grownups.
Older children can often use the smaller-sized adult bags.
Brand/source from left to right: MMGonline,
3X
Coloplast and Convatec Little ones
To conclude : you have to choose individually which system is best for you that is, which gives you the least problems, like skin-irritation or leakage., You can choose from a variety of systems, brands and sizes, depending on the type of stoma you have and your own demands. Click here for different producing firms.
The variety can be overwhelming and choosing a complicated job. In most hospitals a specialized ET (entrastomal therapy) nurse can help you choose. An ET nurse also helps to prepare you for the operation, and assists you in the first period of getting used to your stoma.
They also help you to choose the wafer and bag that are best for you, because without their knowledge and assistance you probably would not know what to pick.
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The wafer
The base plate, also known as flange, is a sort of plaster that is attached to the skin around the stoma. Previously due to its yellow colour it was also called “cheese slice”. The base plate must comply with the following conditions: the protection of the skin against faeces or urine, be skin friendly and user friendly, strong adhesion ability and be flexible, have a good coupling system with the bag and must have an aesthetic (practical) appearance. The absorption capacity (the amount of liquid that a base plate can absorb) varies by the stoma appliance. It depends on the composition and proportion of the ingredients of the base plate. Every manufacturer has its own secret recipe of these components, which consist of; pectin (comes from the cell walls of plants and fruits, giving the colour and body to the plate), gelatine (albumen product from animal bones) natrium caboxy methyl cellulose (produced from wood pulp and has an adhesive and absorptive function) and Polyisobutyleen (produced from oil and only becomes syrupy at high temperatures). This is called hydrocolloid.
Brand:
Eurotec
Hydrocolloïd is a sticky material and has moisture-absorbing qualities. Hydro means water and collo means glue. Hydrocolloïd sticks on a dry skin and on a wet skin. It came on the market as a small plaster for dentists and dental surgeons to use on gums. Later it was discovered to be very useful for the skin around a stoma.
Hydrocolloïd automatically adapts its sticking-power to the level of humidity of the skin, e.g sweating or inflamed skin. Hydrocolloïd seldom causes irritation or skinproblems. But a 100% hydrocolloïd wafer is very stiff. To become more flexible the hydrocolloïd needs to be mixed with other more elastic ingredients , however this diminishes the moisture-absorbing capacity of the wafer. So the manufacturers try to get the best combination of ingredients to make a wafer that is both flexible and highly absorband.
Brand:
Dansac
In this picture you can see the manufacturing of convex wafers in the factory of Eurotec in Roosendaal (The Netherlands). The mixture, with a PET protective layer, is heated and then sucked vacuum in the right shape.
Picture resource:
Eurotec
In the next pictures you see the variety of shapes a wafer can take.
First we show some flat wafers, these can be round, oval, square or wavy.
Brand from left to right:
Hollister,
Dansac,
BBraun and
Coloplast
A wafer can also be convex. The convex wafers have a bulge, and are used for stomas that are retracted or are sunk in the skin. When a stoma lies deep, the urine or stool can easily get under a flat wafer, resulting in leakage. By using a convex wafer the stoma is pushed a bit upwards, thereby making it harder for the discharge to escape under the wafer.
Brand from left to right: Dansac,
Welland and
Hollister
Lately there is also the mouldable base plate. The base plate can be moulded into any form desired, meaning you do not have to cut it out. Because the opening sits well against the stoma, it prevents skin irritations. It is also available in a convex base plate.
Brand:
Convatec
Some base plates now have a plaster edge in place of hydrocolloid, such as beneath. Some people’s skin cannot tolerate this. Do you get a red skin with it? Then try a base plate without a plaster edge.
Brand:
Convatec
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Storing the bags
It is advisable to keep an advance-supply of stoma-appliances for at least two weeks. More is possible, because if you store them well the stoma-wafers and bags will stay unchanged for as long as 5 years.
Storing them well means : in a dry cool place, not too cold and not too warm.
If you leave them in a place where the temperature can go down to the freezing-point, they will deteriorate.
But if you store them near a heater or another place that can get hot, the wafers can melt, and the shape and quality will change.
The shower is not a good place either, being too humid.
In warm countries it is best to keep your supply in a cool box and in summer when you travel by car a cool box is necessary as well.
Brand:
Nu-Hope
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